Canadian Journal of Anesthesia

, 46:1127 | Cite as

Epidural block with mepivacaine before surgery reduces long-term post-thoracotomy pain

  • Hideaki Obata
  • Shigeru Saito
  • Nao Fujita
  • Yoshiaki Fuse
  • Keiji Ishizaki
  • Fumio Goto
Reports of Investigation

Abstract

Purpose

To examine the effect of continuous epidural block initiated before thoracic surgery upon early and long-term postoperative pain.

Methods

In a double-blind study, 70 patients scheduled for thoracic surgery under general anesthesia were assigned randomly to receive continuous epidural block with mepivacaine 1.5% initiated either 20 min before surgical incision (Pre group) or at completion of surgery (Post group). In both groups the initial dose was 4 ml, followed by a continuous infusion at 4 ml·hr−1 until 72 hr after operation. Indomethadn suppositories, 50 mg, were administered on request as supplementary analgesics. Visual analogue scale at rest was assessed four hours after operation, and then every 24 hr after operation on postoperative days 1 through 7, and also days 14 and 30. At three and six months after operation, all patients were interviewed by telephone with respect to postoperative pain. The most severe pain was assessed using modified numerical rating scale.

Results

By a visual analogue scale, postoperative pain was less in the Pre group than in the Post group at four hours, two and three days after operation (P < 0.05). By a numerical rating scale six months after operation, pain was less in the Pre group than in the Post group (P = 0.015). The percentage of pain-free patients was higher in the Pre group than in the Post group at three (P = 0.035) and six (P = 0.0086) months after operation.

Conclusion

Continuous epidural block initiated prior to surgery may reduce long-term post-thoracotomy pain.

Résumé

Objectif

Examiner l’effet d’un blocage épidural continu, amorcé avant une intervention chirurgicale thoracique, sur la douleur postopératoire précoce et de long terme.

Méthode

Létude à double insu a porté sur 70 patients qui devaient subir une opération thoracique sous anesthésie générale. Répartis au hasard, ils ont reçu un blocage épidural continu avec de la mépivacaïne à 1,5 %, administrée soit 20 min avant l’incision chirurgicale (groupe Pré), soit à la fin de l’intervention (groupe Post). Pour tous, la dose initiale a été de 4 ml suivie d’une perfusion continue à 4 ml·hr−1 jusqu’à 72 h après l’opération. Des suppositoires de 50 mg d’indométhacine ont été administrés sur demande pour compléter l’analgésie. La douleur a été évaluée au repos selon l’échelle visuelle analogique, 4 h après l’opération et puis à toutes les 24 h des jours 1 à 7 et aussi les jours 14 et 30. Trois mois et six mois après l’opération, tous les patients ont été interrogés par téléphone au sujet de la douleur postopératoire. La douleur la plus sévère a été évaluée en utilisant une échelle d’estimation numérique modifiée.

Résultats

Selon l’échelle visuelle analogique, la douleur postopératoire était plus faible chez les patients du groupe Pré que chez ceux du groupe Post à 4 h, deux et trois jours après l’opération (P < 0,05). Selon une échelle d’estimation numérique, la douleur était moins intense chez les patients du groupe Pré que chez ceux du groupe Post (P = 0,015) six mois après l’opération. Le pourcentage de patients sans douleur était plus élevé dans le groupe Pré que dans le groupe Post à trois mois (P = 0,035) et à six mois (P = 0,0086) après l’opération.

Conclusion

Le blocage épidural continu amorcé avant l’intervention chirurgicale peut réduire la douleur qui se prolonge après une thoracotomie.

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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Hideaki Obata
    • 1
  • Shigeru Saito
    • 1
  • Nao Fujita
    • 2
  • Yoshiaki Fuse
    • 3
  • Keiji Ishizaki
    • 1
  • Fumio Goto
    • 1
  1. 1.Department of Anesthesiology and ReanimatologyGunma University, School of MedicineMaebashi, GunmaJapan
  2. 2.Department of AnesthesiaSaitama Cardiovascular and Respiratory CenterJapan
  3. 3.Department of AnesthesiaSaitama Cancer CenterJapan

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